{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"NONNAHSXOC K ","gend":1,"add":"RC KAO 201EVIRD TSE","city":"PARTLOW","state":"VA","zip":"22534-9724","dob":"1992-03-18","age":"","mstatus":"","insh":"7218811","cliId":"","pno":"8504594382","cno":8044999723,"email":"","ename":"","eno":"","pphy":"CZAJKOWSKIIII, STANLEY","ppno":8047641253,"pcpadd":"8220 MEADOWBRIDGE RD STE 306,","pcpcity":"Mechanicsville","pcpstate":"VA","pcpzip":"23116-2341","pcpcounty":"","pcpid":"","pcpname":"BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER","plan":"VPHP","program":"MEDICAID","lob":"VPM4","region":"CENTRAL","aligned":"","ano":"","add2":"102 OAK CREST DRIVE","add3":"","madd1":"102 OAK CREST DRIVE","madd2":"","madd3":"","mcity":"PARTLOW","mstate":"VA","mzip":"22534-9724","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["F11.20","R68.89","R06.00","M94.0","R07.9","R05","R74.01","R53.83","R74.02","R53.81","A41.9","J16.8","J02.9","E87.1","D72.829","F17.210","R94.5","R50.81","Z20.822","J96.01","J13","R65.20","B96.20","Z16.24","N30.00","I10","K76.0","G89.29","Z79.891","Z86.16","Z88.0","J18.9","E87.2","R07.0","M54.50","R74.8","D72.825","R10.11","I26.99","J18.1","R10.9","R79.1","J15.9","G89.4","M25.532","S62.102A","S63.502A","S69.92XA","W03.XXXA","Y92.009"],"date":["2023-06-01","2021-02-28","2021-03-08","2021-03-08","2022-03-26","2021-03-08","2021-03-08","2021-10-04","2021-03-08","2021-10-04","2022-03-31","2022-03-15","2022-03-15","2022-03-16","2022-03-26","2022-07-06","2022-03-15","2022-03-15","2022-03-27","2022-03-16","2022-03-16","2022-03-31","2022-03-16","2022-03-16","2022-03-16","2022-07-06","2022-03-16","2022-03-16","2022-03-27","2022-03-27","2022-03-27","2022-03-31","2022-03-16","2022-03-17","2022-03-16","2022-03-27","2022-03-31","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-03-26","2022-03-27","2022-03-27","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06","2022-07-06"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","53489011905","DOXYCYCL HYC","CAP 100MG","8","Select","Select",""],["","68180051303","LISINOPRIL","TAB 5MG","30","Select","Select",""],["","00143992950","CIPROFLOXACN","TAB 750MG","10","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}